Role of adjuvant and posttreatment exercise programs in breast health

Growing evidence suggests that physical activity may be an important part of survivorship care for women with a history of breast cancer. Observational evidence suggests that women who are physically active after breast cancer diagnosis have a 30% to 50% lower risk of breast cancer recurrence, breast cancer death, and overall death compared with sedentary individuals. Although randomized controlled trials have not been performed to test the ability of exercise to improve outcomes in women with early-stage breast cancer, many small intervention studies have shown the safety and potential benefits of exercise in the adjuvant and posttreatment settings. These studies have shown that physical activity can be performed safely both during and after adjuvant treatment for breast cancer, and that women who increase physical activity in these settings experience improvements in fitness, strength, quality of life, and other end points. Although more research is needed to fully define the role of exercise in breast cancer survivors, the many proven benefits of physical activity have led the American Cancer Society and American College of Sports Medicine to encourage regular participation in moderate-intensity recreational activity for most breast cancer survivors. This article reviews the growing evidence that exercise could be an important part of breast cancer survivorship, and describes current exercise guidelines for breast cancer survivors.     

Cancer-related fatigue

Fatigue is a common symptom in patients with cancer and in disease-free survivors. It has a significant impact on the quality of life. Although subjective fatigue is often related to objective changes in physical functioning or impaired performance status, the two phenomena are not synonymous and need to be distinguished. A number of robust and reliable assessment instruments to measure fatigue severity are now available and criteria for cancer-related fatigue syndrome have been proposed. The underlying mechanisms and pathophysiology of cancer-related fatigue are unclear. Management strategies include the use of psycho-educational interventions, exercise programmes and pharmacological treatments. The best evidence for the effectiveness of drug treatments is for the haematopoietic agents in anaemic patients undergoing chemotherapy and for methylphenidate in an on-treatment population.     

有氧运动对缓解鼻咽癌放疗病人癌因性疲乏的效果

目的:观察有氧运动对缓解鼻咽癌放疗病人癌因性疲乏的效果.方法:80例接受放疗的鼻咽癌病人随机分成观察组和对照组,对照组患者放疗期同常规护理和随意自我运动,观察组在此基础上于放疗第1天开始实施连续7周的低强度有氧运动.结果:观察组病人癌因性疲乏的程度低于对照组,生活质量优于对照组,两组比较差异均有统计学意义(P＜0.05).结论:有氧运动能够有效缓解鼻咽癌放疗病人癌因性疲乏和提高生活质量.     

Exercise in patients coping with breast cancer: An overview

Breast cancer is the most common type of cancer in women, but fortunately has high survival rates. Many studies have been performed to investigate the effects of exercise in patients diagnosed with breast cancer. There is evidence that exercise after the diagnosis of breast cancer improves mortality, morbidity, health related quality of life, fatigue, physical functioning, muscle strength, and emotional wellbeing. Based on scientific data, breast cancer patients should be recommended to participate in rehabilitation programs including aerobic and strength training. The aim of this article is to review the recently published data on the effect of exercise in patients with breast cancer in order to present the current perspective on the topic.     

Cancer related fatigue: a focus on breast cancer and Hodgkin's disease survivors

Background and Purpose. Fatigue is one of the most common and troubling symptoms in cancer survivors. In this paper we review information about cancer related fatigue in survivors of breast cancer and Hodgkin's disease, discuss some of the potential biological mechanisms for this problem in cancer survivors, and briefly discuss potential interventions. Findings. Cancer-related fatigue persists long after cancer treatments end, and is associated with more intensive treatments (combined chemotherapy and radiation therapy) in these cancers. Fatigue prior to the onset of treatment is a strong predictor of persistent fatigue. Studies in breast cancer survivors suggest elevated levels of pro-inflammatory cytokines in association with persistent fatigue, as well as abnormalities in the hypothalamic-pituitary axis. Psychosocial and physical activity interventions have been shown in some studies to alleviate fatigue. Conclusions. Recognizing the syndrome of cancer-related fatigue is a high priority for the many cancer survivors who continue to experience this complaint as a chronic health problem.     

The follow-up of breast cancer

Adenocarcinoma of the breast is the most common cancer of American women. Increased incidence and reduced mortality have generated a population of more than 2 million breast cancer survivors who require medical follow-up. In addition to therapy-related complications, these women are at risk for locoregional recurrence, distant relapse, and the development of second primary breast tumors. Medical surveillance after primary breast cancer treatment has historically included regular patient history and physical examinations, complete blood cell counts, comprehensive blood chemistries, tumor markers, mammography, chest x-rays, and sometimes computed tomography (CT) and nuclear medicine bone scans. The use of such intensive surveillance was based on the presumption that detecting disease recurrence at its earliest stage would offer the chance of cure, improved survival, or at least improved quality of life. Here we review the evidence that such intensive surveillance is not cost-effective, and in fact has no significant impact on the overall survival or quality of life of women diagnosed with early-stage breast cancer. Finally, we present an evidence-based approach to breast cancer surveillance after therapy that is consistent with several clinical practice guidelines, maximizing outcome and minimizing cost.     

Implementing the exercise guidelines for cancer survivors

In 2009, the American College of Sports Medicine convened an expert roundtable to issue guidelines on exercise for cancer survivors. This multidisciplinary group evaluated the strength of the evidence for the safety and benefits of exercise as a therapeutic intervention for survivors. The panel concluded that exercise is safe and offers myriad benefits for survivors including improvements in physical function, strength, fatigue, quality of life, and possibly recurrence and survival. Recommendations for situations in which deviations from the US Physical Activity Guidelines for Americans are appropriate were provided. Here, we outline a process for implementing the guidelines in clinical practice and provide recommendations for how the oncology care provider can interface with the exercise and physical therapy community.     

Exercise after diagnosis of breast cancer in association with survival

It has been suggested that exercise following breast cancer diagnosis is inversely associated with mortality. However, controversy exists regarding the causality of such associations. We evaluated associations of exercise after breast cancer diagnosis with total mortality and recurrence/disease-specific mortality, accounting for conditions that restrict exercise participation. The analysis included 4,826 women with stage I to III breast cancer identified 6 months after diagnosis through the population-based Shanghai Cancer Registry and recruited into the study between 2002 and 2006. Exercise was assessed approximately 6, 18, and 36 months postdiagnosis, and metabolic equivalent (MET) scores were derived. Information on medical history, cancer diagnosis, treatments, quality of life (QOL), anthropometrics, and lifestyles were obtained by in-person interviews at 6 months postdiagnosis. Medical charts were abstracted to verify clinical information. During the median follow-up of 4.3 years, 436 deaths and 450 recurrences/cancer-related deaths were documented. After adjustment for QOL, clinical prognostic factors, and other covariates, exercise during the first 36 months postdiagnosis was inversely associated with total mortality and recurrence/disease-specific mortality with HRs of 0.70 (95% CI: 0.56-0.88) and 0.60 (95% CI: 0.47-0.76), respectively. Significant dose-response relationships between total and recurrence/disease-specific mortality rates and exercise duration and MET scores were observed (all values for P(trend) < 0.05). The exercise-mortality associations were not modified by menopausal status, comorbidity, QOL, or body size assessed at approximately 6 months postdiagnosis. An interaction between disease stage and hormone receptor status and total mortality was noted. Our study suggests that exercise after breast cancer diagnosis may improve overall and disease-free survival.     

Impact of Healthy Eating Practices and Physical Activity on Quality of Life among Breast Cancer Survivors

Following breast cancer diagnosis, women often attempt to modify their lifestyles to improve their healthand prevent recurrence. These behavioral changes typically involve diet and physical activity modification. Theaim of this study was to determine association between healthy eating habits and physical activity with qualityof life among Iranian breast cancer survivors. A total of 100 Iranian women, aged between 32 to 61 years wererecruited to participate in this cross-sectional study. Eating practices were evaluated by a validated questionnairemodified from the Women’s Healthy Eating and Living (WHEL) study. Physical activity was assessed usingthe International Physical Activity Questionnaire (IPAQ). A standardized questionnaire by the EuropeanOrganization of Research and Treatment of Cancer Quality of Life and its breast cancer module (EORTCQLQ-C30/+BR-23) were applied to determine quality of life. Approximately 29% of the cancer survivors werecategorized as having healthy eating practices, 34% had moderate eating practices and 37% had poor eatingpractices based on nutrition guidelines. The study found positive changes in the decreased intake of fast foods(90%), red meat (70%) and increased intake of fruits (85%) and vegetables (78%). Generally, breast cancersurvivors with healthy eating practices had better global quality of life, social, emotional, cognitive and rolefunctions. Results showed that only 12 women (12%) met the criteria for regular vigorous exercise, 22% hadregular moderate-intensity exercise while the majority (65%) had low-intensity physical activity. Breast cancersurvivors with higher level of physical activity had better emotional and cognitive functions. Healthy eatingpractices and physical activity can improve quality of life of cancer survivors. Health care professionals shouldpromote good dietary habits and physical activity to improve survivors’ health and quality of life.     

Cancer-related Fatigue in Breast Cancer Survivors: A Review

Fatigue has been the most distressing and frequent symptom in breast cancer (BC) survivors after treatment. Although fatigue can occur in other cancer survivors, women with a history of BC might share some distinctive features. The present study aimed to recapitulate the knowledge about risk factors and correlates of cancer-related fatigue (CRF) in BC survivors after oncologic therapy. An electronic data search was conducted in PubMed using the terms “fatigue,” “breast,” “cancer,” and “survivors.” Records were included if they were original articles, available in English, had used a quantitative scale, had > 100 participants, and had excluded women with BC relapse. BC survivors were required to have finished their treatments ≥ 2 months before, except for hormonal therapy. The physiopathology and other interventions were considered beyond the scope of our review. The correlates were subsequently classified into 7 main categories: (1) sociodemographic data, (2) physical variables, (3) tumor- and treatment-related variables, (4) comorbidities, (5) other symptoms, (6) psychological issues, and (7) lifestyle factors. Fatigue was consistently greater in younger, obese, and diabetic women. Women reporting fatigue often communicated symptoms such as pain, depression, insomnia, and cognitive dysfunction. Coping strategies such as catastrophizing could play an important role in the persistence of fatigue. However, tumor characteristics, previous treatments received, and physical activity were not consistently reported. CRF was a strong predictor of the quality of life of BC survivors after treatment. In conclusion, we found CRF was a frequent and serious symptom that severely affects the quality of life of BC survivors after treatment. Health practitioners require more awareness and information about CRF.     

正念放松训练对乳腺癌患者癌症复发恐惧和癌因性疲乏及睡眠质量的影响

目的 探讨正念放松训练对乳腺癌患者癌症复发恐惧、癌因性疲乏及睡眠质量的影响.方法 选取2019年1月至12月间上海中医药大学附属曙光医院收治的88例首发乳腺癌术后患者,采用随机数字表法分为观察组和对照组,每组44例.对照组患者采用常规护理,观察组患者在常规护理基础上采用正念放松训练,比较两组患者干预前后复发担忧惧量表(...     

Art therapy for anxiety,depression, and fatigue in females with breast cancer: A systematic review

This systematic review employed a meta-analysis to examine the effectiveness of art therapy for treating anxiety, depression, and fatigue in female patients with breast cancer, the most prevalent cancer and the most common cause of cancer-related mortality among women worldwide. The review included nine original studies and analyzed data from a total of 754 patients. Data extraction and quality assessment were conducted by two independent reviewers. In total, 1,466 articles were retrieved. We excluded studies in which the participant, interventions, and study design did not satisfy the inclusion criteria, leaving nine articles for analysis, The Cochrane risk of bias assessment tools were used for quality evaluation. The analysis revealed a significant difference in treatment outcomes between patients who received art therapy and those who did not (SMD?=?–0.48, 95%CI [–0.75, –0.21, p?=?0.0005]). The review provides initial evidence to suggest that art therapy benefits female breast cancer patients with respect to the treatment of anxiety, depression, and fatigue. However, additional and better-quality studies must be conducted, particularly with larger sample sizes, greater specificity of the design of trials and interventions, and a longer follow-up duration.     

Catechol-O-methyltransferase genotype (Val158met) modulates cancer-related fatigue and pain sensitivity in breast cancer survivors

Cancer-related fatigue and pain after surgery are the most frequent and most incapacitating cancer-related symptoms after breast cancer treatment. Genetic influence of cancer-related fatigue and pain has not been previously investigated. Our aim was to examine the influence of catechol-O-methyltransferase (COMT) Val158Met genotypes on cancer-related fatigue, post-mastectomy pain, and pressure pain hypersensitivity in breast cancer survivors. One-hundred and twenty-eight (n = 128) breast cancer survivors who were treated with radiotherapy and chemotherapy participated in this study. After amplifying Val158Met polymorphisms by polymerase chain reaction, COMT genotype was divided into Val/Val, valine/methionine (Val/Met), or Met/Met. The Piper fatigue scale (PFS) was used to assess cancer-related fatigue. Neck and shoulder/axillary pain intensity was assessed with a numerical pain rate scale (0-10). Finally, pressure pain thresholds (PPT) were assessed bilaterally over the C5-C6 zygapophyseal joints, deltoid muscles, second metacarpal, and tibialis anterior muscles. Breast cancer survivors carrying the Met/Met genotype reported higher levels of fatigue (all subscales, P < 0.001), higher neck pain intensity, and lower PPT over C5-C6 joints and deltoid muscles (all, P < 0.001) relative to those with Val/Met or Val/Val genotypes. The results suggest that breast cancer survivors carrying the Met/Met genotype exhibit higher fatigue, neck pain, and pressure pain hypersensitivity over the neck and shoulder area. This study is important because it strives to understand the factors that predispose some breast cancer survivors to more cancer-related fatigue and increased pain sensitivity.     

Predictors of Adherence to Clinical Breast Examination andMammography Screening among Malaysian Women

Breast cancer is the most common cancer among Malaysian women and early detection can play an importantrole in reducing cancer morbidity and mortality. The aim of this cross-sectional study was to determine therates and factors related to clinical breast examination (CBE) and mammography among 425 female teachersin Selangor, Malaysia. A self-administered questionnaire that included questions on socio-demography,cancer-related knowledge practice and an adapted version of Champion’s revised Health Belief Model Scalewas employed. The mean age of participants was 37.2±7.16 years. Only 25% of the women ever had a CBE.Of women over the age 40 (n=138), 13.6% reported having had a mammography. The results showed highersusceptibility to breast cancer, higher benefits of doing CBE and regular visits with a physician to be significantpredictors for undergoing CBE (p<0.05). In addition, higher a perceived susceptibility to breast cancer andregular undergoing CBE were significant predictors for having a mammography. The findings clearly suggest aneed for improving women’s awareness on breast cancer screening, its importance and recommended guidelines.     

Exercise participation after diagnosis of breast cancer: trends and effects on mood and quality of life

Individuals treated for cancer often experience higher levels of emotional distress than the general population. Previous research has shown that exercise can have an ameliorating effect on these problems. This 12-month prospective longitudinal study investigated mood, quality of life, cancer-related symptoms, and exercise behavior of 69 women who had completed treatment for Stage 0-2 breast cancer. We studied the natural progression of exercise participation after cancer treatment. Effects on mood, quality of life, and cancer-related symptoms were assessed after controlling for demographic variables, disease variables, social support, and baseline values to test the hypothesis that women who exercised were more likely to report better mood, higher quality of life, and fewer cancer-related symptoms. Results indicated that women did not increase their exercise participation over time and that overall mean minutes of exercise participation were below recommended levels. Baseline demographic predictors of exercise participation included younger age, having a spouse or partner, increased time since diagnosis, higher social support, and higher depression. Exercise participation was associated with improved physical functioning, but not overall mood or cancer-related symptoms. We discuss implications of these findings towards the well-being of breast cancer survivors.     

A case study: prescriptive exercise intervention after bilateral mastectomies

Exercise for cancer patients is gaining support. In the current case study, a female breast cancer patient was diagnosed with breast cancer at the age of 29 years; she underwent a left modified radical mastectomy. She developed cancer again in the opposite breast at the age of 57 years and had a right modified radical mastectomy. After the second mastectomy (the right breast), the patient received chemotherapy and radiation. Following her cancer treatments, she participated in an exercise intervention for 6 months at the University of Northern Colorado's Rocky Mountain Cancer Rehabilitation Institute. A 6-month reassessment showed that she increased her muscular strength and cardiovascular function in addition to attenuating her cancer-related fatigue and depression. It is recommended that health professionals work together to ensure that a collaborative effort is undertaken to increase functional work capacity that will significantly improve patients' quality of life.     

肿瘤相关性疲乏的研究进展

疲乏是肿瘤患者最常见的临床症状之一，它影响着生活的方方面面，但是该症状始终没有得到足够重视和及时治疗。对肿瘤相关性疲乏的原因及治疗措施、评估量表、治疗方面的相关研究进行综述。     

Effect of a Pedometer-based Exercise Program on Cancer Related Fatigue and Quality of Life amongst Patients with Breast Cancer Receiving Chemotherapy

Background: Breast cancer is the most common cancer amongst Indian women. Cancer treatments leads to various side effects out of which Cancer-Related fatigue (CRF) is one of the most under-addressed side-effects. It is experienced the most in patients receiving chemotherapy. Exercise has been proven to be a beneficial intervention to manage CRF but the benefits of pedometer-based exercise programs is under-studied in patients with breast cancer. Hence, we set out to investigate the effects of a pedometer-based exercise program for patients with breast receiving chemotherapy. Methods: The current study was a non-randomized controlled trial with 22 patients each in exercise and control group. The exercise group received a pedometer-based walking program, whereas the control group received standard physical activity advice. Fatigue, quality of life, functional capacity and body composition were assessed at baseline, 3rd week and 7th week. Results: At the end of 7 weeks intervention, functional capacity, quality of life and skeletal mass were found to have improved with statistical significance, while the fatigue and changes in total fat did improve but were not statistically significant. Conclusion: A 7-week pedometer-based exercise program improved functional capacity, quality of life and percentage of skeletal mass and also shows to have prevented deterioration in fatigue levels in patients with breast cancer receiving chemotherapy.